The investigation into the spatial distribution of living woody (LWD) and coarse woody debris (CWD) within forests represents a fundamental methodology for probing the inherent mechanisms governing coexistence and mortality within forest ecosystems. Here, a complete spatial randomness (CSR) null model was employed to scrutinize the spatial pattern, while canonical correspondence analysis (CCA) and the Torus-translation test (TTT) were utilized to elucidate the distribution patterns of LWD and CWD within warm-temperate deciduous broadleaf secondary forests in Dongling Mountains plot, northern China. The results reveal that both LWD and CWD exhibit an aggregated distribution as the predominant pattern in the Dongling Mountains plot, with the proportion and intensity of aggregation diminishing as spatial scale increases. Specifically, the aggregation intensity g0-10 demonstrates a significant negative correlation with abundance and maximum diameter at breast height (DBH). Notably, the g0-10 of LWD manifests a stronger correlation with the maximum DBH, whereas the g0-10 of CWD exhibits a greater association with the mortality rate. CCA outcomes suggest that elevation, convexity, and aspect significantly impact LWD distribution, whereas CWD distribution shows substantial negative correlations with elevation, convexity, slope, and aspect. TTT findings indicate that ecosystems characterized by a substantial presence of LWD also display a notable prevalence of CWD. Additionally, the majority of species exhibit no habitat preference, displaying neutral habitat connections and low ecological niche differentiation within the sampled plot.

BACKGROUND: Improving the quality of breastfeeding counselling delivered by primary care providers can improve breastfeeding outcomes and ultimately reduce mortality and morbidity of children and mothers. Accurate data on coverage and quality of primary care breastfeeding counselling is essential for monitoring progress; however, global and national indicators are limited. To help address this gap, this study validated indicators of receipt and quality of breastfeeding counselling during routine consultations for infant care at seven primary health facilities across Kosovo.
METHODS: Mothers\' reports of breastfeeding counselling received during routine consultations for their infants (0-12 months of age) were collected by exit interview in 2019 and 2021 (n = 609). Responses were compared against direct observation of their consultation using a structured checklist (reference standard) by a trained third-party observer at the primary care facility. We assessed 13 indicators; ten were related to the receipt and content of breastfeeding counselling, and three were specific to the provider\'s interpersonal skills. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy.
RESULTS: Ten indicators had an agreement rate above 70% and seven indicators had high overall individual-level validity (AUC ≥ 0.7). High prevalence indicators recorded high sensitivity and low specificity, and the inverse for low prevalence indicators. More subjective indicators were less reliable, e.g., mothers over-reported the prevalence of all three indicators related to providers\' interpersonal skills.
CONCLUSIONS: This study offers evidence on breastfeeding counselling quality by validating maternal reports of whether a provider discussed breastfeeding, the clinical content of that counselling, and how it was delivered. It is also situated in a primary care setting within a fragile state of which there is limited evidence. We observed that mothers reported accurately when asked directly to recall breastfeeding counselling services received. However, there is a need to further validate subjective questions about interpersonal skills and other measures for the \'experience of care\' quality dimension.

Remote sensing (RS) is a widely used technology for monitoring mangrove forests, but there are some inconsistencies in their capacity to assess mangrove ecosystem health status. Our review aims to investigate how RS and in situ data are being applied together in assessments of mangrove forest health conditions. Our results showed that commonly the concept of mangrove ecosystem health was not defined and indicators that were not clearly related to it were applied. Furthermore, low to medium spatial resolution satellites were more used to detect changes in the mangrove forests\' environmental condition than the high spatial resolution ones, and the use of RS with data collected in situ was present in only 39% of the articles. We concluded that studies consider vegetation indexes the same as vigor, so the mangrove ecosystem health; and vigor as the only indicator needed, not using in situ data to validate the mangrove health status.

Objective This study aimed to assess the indirect impact of the COVID-19 pandemic on obstetric quality measures. Materials and methods This cross-sectional study was conducted at a private-sector tertiary care hospital in Karachi, Pakistan. Data were collected for specific antenatal, intrapartum, and postpartum care indicators during the initial six months of the COVID-19 phase (March to August 2020) and compared with baseline measures from the preceding six months before the COVID-19 phase (September 2019 to February 2020) using frequencies and percentages. Results During COVID-19, there was a 10% reduction (pre-COVID: 1041 and during COVID: 946) in outpatient obstetric volumes and a 65% increase (pre-COVID: 240 and during COVID: 396) in clinic cancellations, indicating a decreased influx of antenatal patients. Teleclinics served 8.3% (1429/18279) of the total obstetric patients during this period. Marginal decreases were observed in spontaneous vaginal deliveries 1358 (44%) vs 1049 (42.4%) and labor induction rates 818 (26.6%) vs 606 (24.2%). Additionally, there was a slight increase in instrumental deliveries, 121 (3.9%) vs 114 (4.6%) during the COVID phase. However, these changes were not statistically significant. Similarly, no substantial impact was observed on elective and emergency C-sections. Notably, there were more cases of primary postpartum hemorrhage (PPH) during the COVID-19 phase 36 (1.17%) vs 46 (1.86%), and these changes were statistically significant (p= 0.035). Similar trends were observed for eclampsia (p =0.05) and preeclampsia cases (p-value 0.074). However, other maternal morbidity indicators and intrauterine fetal deaths remained relatively unchanged. NICU admissions increased significantly (p=0.001), while early neonatal deaths remained unaffected. Patient satisfaction rates remained steady for inpatients and improved for outpatients during COVID-19. Conclusion The COVID-19 pandemic primarily affected antenatal volumes, neonatal admissions, and maternal morbidity indicators such as PPH, preeclampsia, and eclampsia. Despite the challenges, patient satisfaction and quality care standards were maintained during COVID-19 through new strategies and revised patient care processes.

Climate change challenges public health. Effective management of climate-related health risks relies on robust public health surveillance (PHS) and population health indicators. Despite existing global and country-specific indicators, their integration into local PHS systems is limited, impacting decision-making. We conducted a systematic review examining population health indicators relevant to climate change impacts and their suitability for national PHS systems. Guided by a registered protocol, we searched multiple databases and included 41 articles. Of these, 35 reported morbidity indicators, and 39 reported mortality indicators. Using Chile as a case study, we identified three sets of indicators for the Chilean PHS. The high-priority set included vector-, food-, and water-borne diseases, as well as temperature-related health outcomes indicators due to their easy integration into existing PHS systems. This review highlights the importance of population health indicators in monitoring climate-related health impacts, emphasising the need for local contextual factors to guide indicator selection.
UNASSIGNED: This research project was partly funded by ANID Chile and University College London. None of these sources had any involvement in the research conceptualisation, design, or interpretation of the results.

This study focused on designing a WASH Index for assessing the status of WASH in Primary Healthcare Facilities (PHCs) especially for low- and middle-income countries. To assess the effectiveness of the WASH Index in evaluating the WASH in PHCs, PHCs were selected from 70 Local Government Areas (LGA) across 3 Southwestern States in Nigeria. The WASH index comprises of the five Joint Monitoring Programme service ladders as outlined in the World Health Organization Global Baseline Report for monitoring basic WASH services in health care facilities: water, sanitation, hygiene, waste management and environmental cleaning. The 5 service elements (termed as components) assessed were based on 10 indicators and 30 sub-indicators. The results of the WASH Index of the PHCs were compared statistically on LGA and State basis with emphasis on the status of WASH facilities. The study concludes that the result would further provide baseline information on the status of WASH in PHCs in the selected States in the quest to achieve the Sustainable Development Goals (SDGs). This study recommends that the WASH Index could be adopted an assessment tool for evaluating WASH in PHCs in other to ensure communication of results to policy makers and other relevant stakeholders, for effective monitoring healthcare facilities.

In recent years, Climate-Smart Forestry (CSF) has emerged as an innovative approach to sustainable forest management, aiming to enhance forest resilience and to balance the provision of ecosystem services facing climate-related threats. This study introduces for the first time a new composite climate-smart index (ICSF) to assess CSF. The methodological approach comprises the following steps: (i) the selection and evaluation of CSF indicators; (ii) the weighting of these indicators; and (iii) the assessment of CSF for Mediterranean forests in two distinct periods, specifically 2005 and 2015. Eight indicators were selected from a systematic literature review. The Analytic Hierarchy Process was applied to translate the preferences obtained through an online questionnaire from a network of CSF-expert stakeholders into weights, at both indicators and criteria levels (i.e., adaptation, mitigation, and the social dimension). Results reveals that indicators \"tree species composition\", \"forest damage\", and \"regeneration\" are of crucial importance for CSF assessment. The comparison of the CSF value between the years 2005 and 2015, shows a slight increase in CSF ratings. The ICSF serves as a comprehensive index of CSF covering all aspects of that concept, i.e. adaptation, mitigation, and the social dimension (including production). The national-scale analysis provides an overview of the dynamics that involve forest management of Mediterranean forests against climate change. The study offers a practicable method for CSF evaluation with its allover set of indicators, representing a suitable tool for supporting forest managers to mitigate the negative impacts of climate change.

Antibiotic resistance genes (ARGs) have been extensively observed in bacterial DNA, and more recently, in phage particles from various water sources and food items. The pivotal role played by ARG transmission in the proliferation of antibiotic resistance and emergence of new resistant strains calls for a thorough understanding of the underlying mechanisms. The aim of this study was to assess the suitability of the prototypical p-crAssphage, a proposed indicator of human fecal contamination, and the recently isolated crAssBcn phages, both belonging to the Crassvirales group, as potential indicators of ARGs. These crAss-like phages were evaluated alongside specific ARGs (blaTEM, blaCTX-M-1, blaCTX-M-9, blaVIM, blaOXA-48, qnrA, qnrS, tetW and sul1) within the total DNA and phage DNA fractions in water and food samples containing different levels of fecal pollution. In samples with high fecal load (>103 CFU/g or ml of E. coli or somatic coliphages), such as wastewater and sludge, positive correlations were found between both types of crAss-like phages and ARGs in both DNA fractions. The strongest correlation was observed between sul1 and crAssBcn phages (rho = 0.90) in sludge samples, followed by blaCTX-M-9 and p-crAssphage (rho = 0.86) in sewage samples, both in the phage DNA fraction. The use of crAssphage and crAssBcn as indicators of ARGs, considered to be emerging environmental contaminants of anthropogenic origin, is supported by their close association with the human gut. Monitoring ARGs can help to mitigate their dissemination and prevent the emergence of new resistant bacterial strains, thus safeguarding public health.

Diets, but also overall food environments, comprise a variety of significant factors with direct and indirect impacts on human health. Eco-Regions are geographical areas with a territorial approach to rural development, utilizing organic food and farming practices, and principles and promoting sustainable communities and food systems. However, so far, little attention has been given to quantifying aspects of the health of citizens living in these sustainable transition territories. The project \"Indicators for Assessment of Health Effects of Consumption of Sustainable, Organic School Meals in Eco-Regions\" (INSUM) aims to identify and discuss research approaches and indicators that could be applied to effectively measure the somatic, mental, and social health dimensions of citizens in Eco-Regions, linked to the intake of organic foods in their diets. In this paper, we focus on the somatic (physical) health dimension. A two-day workshop was held to discuss suitable methodology with an interdisciplinary, international group of experts. The results showed the limitations of commonly used tools for measuring dietary intake (e.g., relying on the memory of participants), and nutritional biomarkers (e.g., variations in correlations with specific intakes) for research understanding dietary intake and the health effects of diets. To investigate the complexity of this issue, the most suitable approach seems to be the combination of traditional markers of physical and mental health alongside emerging indicators such as the microbiome, nutrigenomics, metabolomics, or inflammatory biomarkers. Using new, digital, non-invasive, and wearable technologies to monitor indicators could complement future research. We conclude that future studies should adopt systemic, multidisciplinary approaches by combining not only indicators of somatic and mental health and social wellbeing (MHSW) but also considering the potential benefits of organic diets for health as well as aspects of sustainability connected to food environments.

To identify the signs and symptoms that people living with acetabular hip dysplasia (AHD) describe and to provide an aid for translating the findings into practice.
A three-phased mixed methods study. Phase 1 employed an open-question online survey that enabled people with AHD (aged ≥16 years) to describe features associated with their condition. Responses were thematically analysed. A Phase 2 survey used these themes to establish how common those features were. Phase 3 created a mnemonic that prompts clinicians to suspect AHD.
Ninety-eight respondents completed Phase 1 and sixty-two completed Phase 2. From the responses, five themes were identified: Demographic and Diagnostic Profile; Characteristics of Posture and Gait; Pain; Childhood Hip and Family History; and Hip Joint Characteristics. Within these themes, 19 common signs and symptoms were reported, represented by the ALPHA mnemonic. ALPHA describes a young age at onset of problems (Age), a limp (Limp), progressing pain (Pain), a history of childhood and family hip anomalies (History) as well as hip joint hypermobility and instability (Articulation).
The findings extend current understanding of AHD indicators. ALPHA alerts clinicians to suspect a diagnosis of AHD. ALPHA may facilitate timelier referral of patients for diagnostic X-Ray and appropriate treatment. Future studies should evaluate its clinical utility.